This is an NIH Pathway to Independence Award (K99/R00) grant proposal, intended to foster the career of Dr. Katherine Tumlinson, PhD, a post-doctoral research fellow at Princeton University's Office of Population Research (OPR), into a path of independent research. The Candidate is a trained epidemiologist with a significant track record of research in the field of family planning and population health. Her goal is to integrate her prior training in rigorous quantitative methodology with focused training in qualitative research methods and health systems to become a leader in the field of contraceptive research with the ability to apply a mixed- methods and interdisciplinary approach to reduce unintended fertility in developing countries. During the mentored K99 phase the Candidate will expand her quantitative and qualitative research skills and cross- disciplinary training by interacting with both ethnographic and statistical experts who are productive scientists in population and health research, engaging in formal didactics, attending multidisciplinary seminars, journal clubs, and scientific meetings, participating in study activitis with her mentors, and by leading a project that develops novel approaches to defining and assessing quality of care in the context of family planning service delivery in developing countries. These activities will be supervised by mentor Dr. Doug Massey PhD, Princeton's Henry G. Bryant Professor of Sociology and Public Affair and three co-mentors: Dr. German Rodriguez PhD, Senior Research Demographer at OPR; Dr. Sian Curtis PhD, Research Associate Professor in Maternal and Child Health at University of North Carolina; and Dr. Jeffrey Hammer PhD, Princeton's Charles and Marie Robertson Visiting Professor in Economic Development. In addition, a team of collaborators with complementary areas of expertise will supplement Dr. Tumlinson's training in specific areas. Together, the mentor, co-mentors, and collaborators are fully committed to assisting the Candidate reach her research training and career development goals and to ensuring the Candidate's successful transition from postdoctoral fellow to independent researcher. During the independent K99 award phase, the Candidate will obtain additional training in mixed methods research and developing country health systems and will use secondary data to assess the relationship between quality of care, as traditionally defined, and continued contraceptive use. During this time Dr. Tumlinson will also design and implement primary data collection activities in Western Kenya that integrate qualitative research techniques and health systems approaches. During the independent R00 award phase, the Candidate will apply the cross-disciplinary tools developed during the K99 component to assess critical service delivery barriers in Kenya. The proposed research is both novel and of major public health importance, with enormous relevance for reducing maternal, infant, and child mortality in developing country settings. The short-term benefits from this study will be a contribution to the understudied area of family planning service delivery barriers resulting from chronic absenteeism, bribery, and patient abuse.